tbuckley/cabot-search huggingface dataset:
Abstract P599: Should Regression Calibration or Multiple Imputation Be Used When Calibrating Different Devices in a Longitudinal Study?
Authors: Matthew S Loop, Sarah C Lotspeich, Tanya P Garcia, Michelle L Meyer
Journal: Circulation (2023)

Objective: In longitudinal studies, devices used to measure exposures, like pulse wave velocity (PWV), can change from visit to visit. Calibration studies, where a subset of participants receive measurements from both devices at follow-up, are often used to assess differences in the device measurements. Regression calibration and multiple imputation are common statistical methods to correct for those differences, but no study yet exists to compare the two when the quantity of interest is change in the exposure over time. We compared both methods in a hypothetical study of change in PWV and its association with total brain volume. Methods: We simulated true values of PWV at baseline and follow up, as well as imperfect measurements of PWV using an “old” device and “new” device. Two statistical methods were compared: regression calibration , which calibrates the new device measurements at follow up to the old device using linear regression in a calibration study; and multiple imputation , which imputes the (mostly) missing old device measurements at follow up.We varied the bias and measurement error of each device and for each scenario simulated 1,000 datasets of size n=2,500. Two percent of participants in each iteration were chosen to participate in the calibration study, and thus had measurements on the old and new devices at follow up. We used 200 bootstrap replicates to calculate the standard errors for the regression calibration method and 50 imputed datasets for the multiple imputation method. To compare the methods we used bias of the estimated association and how well the standard errors approximated the empirical standard errors. Results: Regression calibration was virtually unbiased for the association between change in PWV and total brain volume when the old device had larger measurement error than the new device. The maximum bias for regression calibration across all scenarios was still small (6%). When the old device had more measurement error or the two devices had equal measurement error, multiple imputation underestimated the association by more than 10%. This underestimation was reduced to approximately 2% when the new device had a larger measurement error than the old device. In all scenarios, regression calibration underestimated the empirical standard error by approximately 35%, while multiple imputation underestimated it by only 2-5%. Conclusions: In analyses of change in PWV and total brain volume, when unbiased estimation is the main objective, regression calibration is favorable to multiple imputation. When null hypothesis significance testing is the main objective, multiple imputation may be favorable in order to not underestimate the standard errors. We expect these conclusions to apply to other change in exposure and outcome relationships with similar ratios between the association’s magnitude and the amount of measurement error.
Abstract P533: Consumption of Foods Away From Home and Cardiometabolic Risk Among Adults in Puerto Rico
Authors: June O'Neill, Josiemer Mattei, Katherine L Tucker, Jose F Rodriguez-Orengo
Journal: Circulation (2023)

Consuming foods away from home (FAFH) is prevalent in the United States and contributes to high food spending and daily energy intake. We recently showed that adults in Puerto Rico (PR) who frequently consume FAFH had lower diet quality and adherence to dietary recommendations. It remains unknown if these associations translate into poor cardiometabolic health. We aimed to determine the association between the consumption of FAFH and cardiometabolic risk factors among adults in PR. Data were obtained from 1,246 adults (30-75 years) in the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic disease Trends (PROSPECT). Participants self-reported the frequency of consuming FAFH for any meal as "rarely" (&lt;2 times/week), "sometimes" (2-4 times/week), or "frequently" (&gt;4 times/week) at various commercial or noncommercial venues. A food frequency questionnaire assessed usual diet, and the Alternate Healthy Eating Index (AHEI) was calculated to capture diet quality. Clinical and laboratory markers from fasting blood samples were measured using standardized protocols. Generalized linear regression models were used to obtain means (SE) of cardiometabolic markers by FAFH category adjusted for sociodemographic and lifestyle behavioral factors. A second model was adjusted for AHEI. Frequently consuming commercial FAFH (cFAFH) was reported by 15.8% (192 of 1,218) and noncommercial FAFH (ncFAFH) by 4.4% (54 of 1,217), while cFAFH sometimes was reported by 31.8% (387 of 1,218) and ncFAFH by 19.0% (231 of 1,217). Participants who reported consuming cFAFH frequently (vs. rarely) had significantly higher waist circumference (107 (1.6) vs. 103 (1.3) cm; P= 0.003), BMI (31.5 (0.82) vs. 29.9 (0.64) kg/m 2 ; P= 0.032), and insulin (geometric mean 9.4 (2.1) vs. 7.8 (2.0) μIU/mL; p&lt;0.001), and lower HDL-C (geometric mean 42.9 (1.0) vs. 45.6 (1.0) mg/dL; P= 0.012). Participants who reported consuming cFAFH sometimes (vs. rarely) had significantly higher plasma triglycerides (geometric mean 126.1 (1.5) vs. 102.1 (1.4) mg/dL; P= 0.012). Plasma glucose ( P= 0.004) and insulin ( P= 0.041) were higher in individuals frequently reporting (vs. rarely) consuming ncFAFH. Adjusting for AHEI did not appreciably change the models, except to nullify the association with BMI. Consuming FAFH, especially &gt;4 times/week, was associated with adverse adiposity, lipids, and glucose markers and generally independent of overall diet quality. Future studies should identify the directionality of these associations and the potential mechanisms connecting them to cardiometabolic markers. Policymakers and food producers should enhance the quality of FAFH for commercial and at-home consumption for better cardiometabolic health.
Abstract P425: Diets Enriched in Stearate, Palmitate, and Oleate Differentially Modulate Gut Microbiome Composition in Post-Menopausal Women
Authors: Wen Zhang, Gregory Matuszek, Alice H Lichtenstein, Nirupa R Matthan
Journal: Circulation (2023)

Objective: Dietary stearic acid (18:0), a major saturated fatty acid (SFA) in Western diets, does not raise plasma LDL-C concentrations relative to other shorter chain SFAs (palmitic [16:0], myristic [14:0] and lauric [12:0]), and is associated with lower CVD risk. We investigated whether the cardioprotective effects of 18:0 and its metabolic product oleic acid (18:1, a monounsaturated fatty acid) relative to 16:0 is mediated via alterations in the gut microbiome. Methods: Twenty mildly hypercholesterolemic (LDL-C&gt;100mg/dL) post-menopausal women (50-85 years; BMI 25-35kg/m 2 ) consumed each of 3 isocaloric diets for 5 weeks according to a randomized controlled cross-over design. Diets provided 55%E carbohydrate, 15%E protein and 30%E fat with half of the fat provided by 16:0, 18:0 or 18:1, respectively. Fecal samples were collected at the end of each diet phase and shotgun metagenomic sequencing was performed. Alpha diversity (Shannon index, Simpson index and observed counts) was compared between diet groups using two-sample non-parametric tests. Beta-diversity was assessed using Bray-Curtis dissimilarity with PERMANOVA test. Differences in metagenomic features by diet group were evaluated using Partial Least Squares-Discriminant Analysis (PLS-DA) models of pairwise diet differences developed using the R package ‘mixOmics’. Results: No significant differences were observed in alpha and beta diversity between diet groups. However, the variability in microbial relative abundance was greater after participants consumed the 18:0 and 18:1 diets compared to the 16:0 diet. Specifically, mean relative abundance of Bacterioides dorei , Bacteroides vulgatus , and Ruminococcus were highest after participants consumed the 18:0 relative to the 16:0 diet and intermediate after the 18:1 diet. The relative abundance of Coprococcus , Parabacteroides distasonis , Coprobacillus and Blautia were higher after participants consumed the 18:1 relative to the 16:0 diet. These microbial species have been associated with several anti-inflammatory pathways and decreased bacterial lipopolysaccharide production. Conclusion: These data document modest but distinctive effects of dietary SFAs on gut microbiome composition and functionality, suggesting that the favorable effects of 18:0 and 18:1 relative to 16:0 on CVD risk factors could be mediated, in part, by the gut microbiome.
Abstract P140: Potential Mediators for Cardiovascular Benefits of Novel Diabetes Medications: A Meta-Regression Analysis
Authors: Jose M Rodriguez Valadez, Malak Tahsin, Umesh Masharani, Meyeon Park, M.G. Myriam Hunink, Joseph Yeboah, Lihua Li, Ellerie Weber, Yan Li, Asem Berkalieva, Luuk Avezaat, Wendy Max, Kirsten E Fleischmann, Bart S Ferket
Journal: Circulation (2023)

Background: Prior research suggests cardiovascular (CV) benefits of glucose-lowering interventions may be mediated by changes in hemoglobin A1c (HbA1c), bodyweight, systolic blood pressure (SBP), hematocrit, and urine albumin-creatinine ratio (uACR). We evaluated the heterogeneity of CV benefits by these potential mediators for sodium-glucose transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) using a meta-analytic approach. Methods: We performed a systematic review and meta-regression analyses of 12 SGLT2i and 9 GLP-1RA CV outcome trials using linear mixed models of treatment efficacy measured as log hazard ratios (HRs) vs changes in potential mediators. We extracted follow-up mediator data for treatment and control, preferably at 12 months post randomization. Outcomes included MI, stroke, and MACE (a composite of MI, stroke, or CV death). We investigated slope differences between drug classes using interaction terms and likelihood-ratio tests. Results: Treatment efficacy for MACE improved with more HbA1c reduction among GLP-1RA (slope .26; P slope .02) but not among SGLT2i trials (slope -.22; P slope .39; P interaction .06), see Figure . Treatment efficacy for MACE, MI, and stroke decreased with more weight loss for SGLT2i (slope –.17, –.29, –.39; P slope &lt;.05) but not for GLP-1RA trials (slope .05, .03, .07; P slope .30, .62, .32). Slopes differed significantly between drug classes: P interaction &lt;.05. For stroke, we observed a trend of less treatment efficacy with increases in hematocrit among five SGLT2i trials with available data (slope .96; P slope .07). We did not find any indication of mediation effects by SBP and uACR for SGLT2i or GLP-1RAs (slopes -.11 -.07; P slopes ≥ .05). Conclusion: We confirm previous findings of increased CV benefits with reductions in HbA1c for GLP1-RAs. Further research is needed to investigate the potential loss of SGLT2i efficacy with greater weight loss and increase in hematocrit.
Abstract P418: Dietary Glutamine and Glutamate in Relation to Cardiovascular Disease and Mortality in Adults With Type 2 Diabetes
Authors: Zhangling Chen, Yang Hu, Frank Hu, Joann E Manson, Eric B Rimm, Alessandro Doria, Qi Sun
Journal: Circulation (2023)

Background: The potential health effects of dietary glutamine and glutamate have been studied in healthy populations, but evidence among individuals with type 2 diabetes (T2D) who have altered macronutrient metabolism and elevated cardiovascular disease (CVD) risk is limited. Objectives: We aimed to examine dietary glutamine and glutamate in relation to subsequent risk of CVD, including coronary heart disease and stroke, and all-cause and cause-specific mortality among individuals with T2D. Methods: We prospectively followed 15,040 men and women with T2D at baseline or diagnosed during follow-up (Nurses' Health Study: 1980-2014, Health Professionals Follow-Up Study: 1986-2018). Diet was repeatedly assessed using validated food frequency questionnaires every 2-4 years since baseline. Associations of energy-adjusted glutamine and glutamate intake, as well as their ratio, with CVD risk and mortality were assessed using Cox proportional hazards models with adjustments for demographics, dietary and lifestyle factors, and medical history. Results: During 196,955 and 225,371person-years of follow-up in participants with T2D, there were 2,927 incident CVD cases and 4,898 deaths, respectively. Higher intake of glutamine was associated with lower risk of incident CVD, total mortality and CVD mortality: comparing extreme quintiles, the HRs (95%CIs) were 0.88 (0.77, 0.99), 0.85 (0.77, 0.94), and 0.82 (0.69, 0.98), respectively (all P trend &lt;0.05). In contrast, higher intake of glutamate was associated with higher risk of incident CVD, total mortality, and CVD mortality; the HRs were 1.30 (1.15, 1.46), 1.19 (1.08, 1.31), and 1.42 (1.21, 1.67), respectively (all P trend &lt;0.05). Furthermore, comparing extreme quintiles, higher dietary glutamine-to-glutamate ratio was associated with lower risk of CVD incidence (0.84 (0.75, 0.95)), total mortality (0.83 (0.76, 0.91)), and CVD mortality (0.69 (0.59, 0.80)). In addition, compared with participants without increment in glutamine-to-glutamate ratio from pre- to post-diabetes diagnosis, those who increased the ratio had a 15% (3%, 25%) lower CVD mortality. Conclusions: In patients with T2D, dietary glutamine and glutamate demonstrated divergent associations with CVD incidence and mortality, and higher dietary glutamine-to-glutamate ratio was significantly associated with lower CVD incidence and mortality. These data suggest a potential critical role of these two amino acids in the etiology of cardiometabolic diseases and early deaths also among adults with T2D.
Abstract P588: The Association of Anthropometric Measures With Risk for Pre-HF
Authors: Jill H Esquivel, Jeongok G Logan, Daniela Sotres-Alvarez, Sonia Ponce, Matthew A Allison, Barry E Hurwitz, Robert Kaplan, Carmen R Isasi, Jainwen Cai, Martha L Daviglus, Mayank M Kansal, Carlos J Rodriguez
Journal: Circulation (2023)

Introduction: Obesity is an epidemiologic challenge and a key risk factor for heart failure (HF). Pre-heart failure (pre-HF) has been recognized as an important entity to prevent progression to clinical HF. Defining the long-term effect of obesity on pre-HF is essential for understanding of HF risk and prevention. Purpose: To determine the prospective association of obesity on the incidence of pre-HF (defined as the presence of abnormal cardiac structure or function among persons without clinical HF). Methods: Data from 1580 individuals without HF and with anthropometric data from the population-based Echocardiographic-Study of Latinos were included. Pre-HF was defined as: 1) Systolic dysfunction - LV ejection fraction (LVEF) &lt; 50% and global longitudinal strain (GLS) &lt;15%; 2) LV diastolic dysfunction - E/e’ &gt;10 and left atrial volume index (LAVI) &gt;34 mL/m 2 ; or 3) LV remodeling - LV mass index (LVMI)&gt; 115gm/m 2 , &gt;95gm/m 2 (male and female, respectively) and relative wall thickness (RWT) &gt;0.42. Anthropometric data were: (body mass index {BMI}, waist circumference {WC}, waist-to-hip ratio {WHR}, fat mass {FM) and free fat mass {FFM}). Echocardiographic and anthropometric data were collected twice, on average 4.3 years apart, and analyzed using survey-weighted multivariable-adjusted regression models. Incident pre-HF was determined among participants Results: Mean age of 56 (42-74) years and 1048 (66%) were female. Baseline mean BMI was 29.9 kgm 2 , FM kg 28.3, FFM kg 50.1, WC 99.7cm, and WHR 0.94. Baseline BMI, FFM, FM, WC and WHR were significantly higher in individuals with prevalent pre-HF (all p&lt;0.007). Longitudinal data showed that WC and WHR were associated with greater probability of incident pre-HF (WC and WHR p&lt;0.0006. Regression models showed BMI, WC, WHR and FFM were associated with increased odds of incident Pre-HF (Table 1).
Abstract P136: Young Women Accept a Developmentally Appropriate Cardiovascular Risk Assessment Tool That Changes Their Perceived Risk of Heart Disease
Authors: Brianna Karim, Andrew Jergel, Shasha Bai, Kolbi Bradley, Santiago J Arconada Alvarez, Amanda K Gilmore, Morgan Greenleaf, Melissa J Kottke, Maren Parsell, Sierra Patterson, Mercedes Sotos-Prieto, Elizabeth Zeichner, Holly C Gooding
Journal: Circulation (2023)

Introduction: Cardiovascular disease (CVD) remains the leading cause of death for women in the US, yet many young women are unaware of their lifetime risk of CVD. We employed user-centered design principles to adapt a validated CVD risk prediction tool for young women. Hypothesis: We hypothesized that young women would rate the tool (HerHeart) as user-friendly, be likely to recommend it to their friends, experience a change in their perceived risk of CVD, and report intent to change their health habits after engaging with it. Methods: We recruited 13 young women ages 13-21 from two clinical practices in Atlanta, GA to engage with the HerHeart CVD risk prediction tool. Participants rated the tool’s usability via the Website Analysis and Measurement Inventory (WAMMI), which is scored from 0 to 100. Participants rated their perceived 10-year and lifetime risk of CVD on a visual analog scale from 0 (Never going to happen) to 10 (Definitely will happen) before and after completing the tool. Participants reported their likelihood of recommending the tool to their friends and changing their health habits from 0 (Not likely at all) to 10 (Extremely likely). Results: Participants rated the tool’s usability highly on the WAMMI (M = 78.62 +/- 9.70). Participants’ perceived 10-year risk of a heart attack increased from a mean of 0.85 +/- 0.99 to 1.83 +/- 1.90, and perceived lifetime risk increased from a mean of 2.38 +/- 2.72 to 2.75 +/- 2.63, on the 10-point scale after engaging with the tool. Participants were more than likely to recommend HerHeart to their friends (M = 8.00 +/- 2.22) and to report intent to change their health habits (M = 8.82 +/- 1.47) after completing the tool. Participant data captured in the HerHeart tool are shown in the Table. Conclusions: The HerHeart tool is acceptable to young women and demonstrates potential for changing their risk perception and improving their health habits to reduce their risk of CVD. Recruitment is ongoing and will include input from clinicians on the feasibility of incorporating the tool in clinical practice.
Abstract P667: Association of Number of Calcified Coronary Arteries and Cardiovascular Outcomes Stratified by Calcification Volume: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Mikaila P Reyes, Tara S Allen, Michael H Criqui, Jonathan M Kermanshahchi, Julie O Denenberg, Harpreet S Bhatia
Journal: Circulation (2023)

Background: Coronary artery calcium (CAC) is a risk factor for atherosclerotic cardiovascular disease (ASCVD). Data suggests number of vessels with CAC independently improves risk prediction but impact by CAC volume remains unknown. Methods: Using data from 3256 MESA participants with CAC&gt;0 and clinical follow-up, we evaluated the association between number of arteries with CAC and risk for coronary heart disease (CHD), myocardial infarction (MI), and CVD events stratified by CAC volume (above/below median) using multivariable-adjusted Cox proportional hazards models. Results: Mean age was 63.3 years (SD 9.5) with 1363 (41.9%) women. There were 1079 (33%) with single-vessel, 822 (25%) with 2-vessel, and 1355 (42%) with 3-4 vessel CAC. Median CAC volume was 84.7 [IQR 24.5, 267.2] mm 3 . CAC in 3-4 vessels was independently associated with higher CHD risk ( Figure ) compared to 1-vessel (HR 2.01, 95% CI 1.1-3.6; p=0.018) and 2-vessels (HR 1.69, 95% CI 1.0-2.8; p=0.04) for lower CAC volumes, with similar findings for MI and CVD outcomes ( Table ). Conclusions: Number of arteries with CAC independently increases risk for ASCVD events only for those with lower CAC volumes.
Abstract MP68: Adipokines as Mediators in the Association of Changes in Physical Activity With Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Amelia S Wallace, Bige Ozkan, Roberta Florido, Justin B Echouffo Tcheugui, Erin D Michos, VIJAY NAMBI, Ebenezer K Aryee, Ron C Hoogeveen, Christie M Ballantyne, Josef Coresh, Elizabeth Selvin, Chiadi E Ndumele
Journal: Circulation (2023)

Background: Physical activity (PA) patterns over time influence diabetes risk through incompletely understood mechanisms. Adipokines secreted by adipose tissue have myriad endocrine effects and are affected by PA. It is unknown the extent to which adipokines mediate the association between changes in PA and diabetes. Methods: We conducted a cross-sectional study of 10,908 ARIC participants (mean age 54; 55% female; 21% Black adults) who attended Visits 1 (V1; 1987-1989) and 3 (V3; 1993-1995) of the ARIC Study. We used mediation analyses to determine the extent to which the association of changes in PA from V1 to V3 and diabetes status at V3 was explained by adipokines. Analyses were stratified by obesity status. PA was defined using American Heart Association guidelines as inactive, intermediate, and recommended (150 minutes of moderate-vigorous activity/week); the intermediate group was further divided into low and moderate (below or above the median activity level). Participants were categorized by PA at V1 and V3 - (1) stable low: inactive or low at both visits; (2) increasing: higher category at V3 than V1; (3) decreasing: lower category at V3 than V1; and (4) stable high: moderate or high at both visits. Results: Increasing PA was associated with higher adiponectin and lower leptin at V3 compared to stable low PA, while decreasing PA was associated with lower adiponectin and higher leptin compared to stable high PA (p&lt;0.01 for all comparisons). Decreasing PA was associated with 28% higher odds of diabetes compared to stable high PA (Table). Conversely, increasing PA was associated with 12% lower odds of diabetes compared to stable low PA. In mediation analyses, adjustment for leptin/adiponectin ratio explained 45% of the effect of increasing PA and 35% of the effect of decreasing PA. The directionality of associations was similar in obesity stratified analyses, but results were not statistically significant. Conclusions: The associations between changes in PA and diabetes may be mediated in part by adipokines.